Neuropsychiatry of Nutritional Disorders Flashcards
What is malnutrition?
A state of nutrition in which deficiency or excess of energy, protein and other nutrients causes measurable adverse effects on tissue,body form, function, and clinical outcome’ (Joosten and Hulst 2008)
What are the two routes to malnutrition?
- Insufficient or inappropriate food intake
- Normal intake, but failures of digestion/metabolism
What are the two major categories of malnutrition?
- Marasmus – calorie deficiency
- Kwashiorkor – protein deficiency
What are characteristics of Kwashiorkor?
-swelling of legs (oedema)
-sparse hair
-moon face, with little interest in surroundings
-flaky appearance of skin
-swollen abdomen
-thin muscles, but fat present
What are the characteristics of marasmus?
-normal hair
-old man or wizened appearance
-thin limbs with little muscle or fat
-very underweight body
How is malnutrition classified?
-Waterlow criteria (1972): measures based on weight and height compared against population norms
-WHO criteria (1999): number of SDs between observed and expected values for weight and height, (-2 = moderate, -3 = severe).
What is acute starvation?
CNS is usually among the last body systems to be affected. May be delirium and encephalopathy, followed by coma.
What is chronic starvation?
malnutrition – not fatal, but causing long-term problems. More relevant to neuropsychiatry
What is pyloric stenosis?
-Pyloric stenosis is a narrowing of the pylorus, the opening from the stomach, into the small intestine.
-a brief period of starvation in early infancy, is unrelated to socioeconomic conditions, and is easily correctable”
(Klein et al 1975)
-History of pyloric stenosis associated with short-term memory and attentional deficits
What were the findings of the Barbados Nutrition Study
(BNS, Galler et al 1989, 2012)?
-40 year longitudinal study
-Individuals with normal birth weight but period of protein-energy malnutrition in first year of life
-Early malnutrition associated with:
Attentional deficits
Hyperactivity
Lower IQ and increased prevalence of learning disability
Subtle motor deficits
What are specific nutritional deficiencies?
-Arise when diet is deficient in one or more nutrients but adequate for others
-Micronutrients – vitamins, minerals, trace elements
-Macronutrients – proteins, fats, carbohydrates
What is thiamine (B1) deficiency?
-Strongly associated with alcohol dependency
Poor diet
-Alcohol compromises the absorption and utilisation of thiamine
Approx 30% of alcoholics are thiamine-deficient
-Also seen in malabsorption syndromes and conditions that involve protracted vomiting
What are B1 rich food?
-green peas
-tomatoes
-sunflower seeds
-brussel sprouts
-black beans
-macadamia nuts
-spinach
What is beriberi?
Weakness, lassitude, myalgia, cardiac problems
What is ‘wet beriberi’?
– dominated by cardiac failure and oedema
What is ‘dry beriberi’?
dominated by neurological features – peripheral nerve damage leading to sensory and motor deficits, muscle wasting
What is the classic triad for Wernicke’s encephalopathy (WE)?
-Acute presentation – classic ‘triad’:
Confusion
Cerebellar ataxia
Opthalmoplegia
Treat with high dose parenteral thiamine
-Often fatal if untreated
85% of survivors of alcoholic WE progress to Korsakoff syndrome (KS)
Outcomes better in non-alcoholic WE
What are the brain regions for wernicke’s encephalopathy?
-Mammillary bodies
-Thalamus
-Superior colliculi
Walls of the third ventricle
Pons, medulla, brainstem
Cerebellar vermis
What is Korsakoff syndrome?
-Characterised by confabulation
-Not reversible by thiamine
May require long-term specialist care
-Atrophy of mammillary bodies seen in approx. 80%
How does niacin (B3) deficiency present?
Pellagra
Dermatitis
Diarrhoea
Dementia (but psychiatric symptoms v. variable)
(Death)
What are vitamin B3 rich foods?
-poultry
-spinach
-peanuts
-fish
-potatoes
-liver
-tomatoes
-mushrooms
-meat
What is B12 deficiency?
-Common (2 – 12% in first world, approx. 30% in developing countries), higher in elderly
-Involved in myelin production (as is folate)
-Loss of vibration sense
-Subacute combined degeneration of the spinal cord
What does the subacute degeneration of the cord in B12 deficiency indicate? What do patients present with?
Affects dorsal and lateral columns of the cord
Causes sensory disturbance (numbness, tingling, loss of sensation)
If untreated, progresses to motor deficits – spasticity, paraplegia, ataxia
Potentially reversible with B12
What effect does nitrous oxide have on B12?
-Inactivates B12
-Use as ‘party drug’ leading to rise in cases of subacute combined degeneration of cord in otherwise healthy young people